Impact/Purpose:

The initial intent of this paper was to conduct a literature review of the costs of asthma, but available studies were based on data from the mid-1980s. With significant changes in asthma prevalence and in asthma treatment in the last decade, it was clear that the available estimates needed to be updated by more than simple inflation factors. Readily available data from the mid-1990s on the usage of asthma-related health care services (e.g., hospitalizations, emergency room visits), asthma-related mortality, and the number of individuals with asthma were combined with inflation-adjusted costs from the available literature to update the national cost of asthma estimates to 1997.

Description:

This paper reviews available national cost of asthma estimates and updates them to 1997, accounting for increases in prices of medical goods and services, changes in the usage of asthma-related medical goods and services, and changes in asthma prevalence and mortality. Available estimates were based on original data from the mid-1980s. The national costs of asthma at that time ranged from $4.5 to $5.0 billion. These estimates include direct costs, which are medical expenditures (e.g., for hospitalizations and emergency room visits), and indirect costs, which are lost wages and productivity as a result of asthma-related morbidity (e.g., lost school and work days) and mortality. The best estimate of the national costs of asthma in 1997 is between $8 billion and $11 billion, with direct medical expenditures representing 55% to 70%, indirect morbidity costs representing 15% to 30%, and indirect mortality costs representing about 15%. Asthma prevalence increased by nearly 70% from 1984-1986 to 1995-1996, far outpacing the 12% growth in population. However, accounting for a doubling in the medical price index, the average costs per person with diagnosed asthma have decreased, in real terms, over this period. Asthma-related outcomes such as hospitalizations, emergency room visits, physician visits, and mortalities have declined on a per-asthmatic basis, suggesting that changes in treatment and management of asthma may be having a positive impact. This is consistent with the roughly doubling in prescription medication expenditures, even after accounting for the substantial increases in prescription prices during this period. This reflects a growing reliance on prescription medications to control asthma symptoms. However, there is some indication that prescription medication use is still not at a level recommended by the medical experts for optimal management of asthma symptoms. In addition, this paper shows that the financial burden of treating asthma falls more directly on the patients and their families, with out-of-pocket expenses estimated at roughly 25% of total medical costs, compared to 10% for medical expenses for all illnesses. This difference is attributed largely to less coverage for asthma-related expenses by Medicare, reflecting its general low coverage for prescription medications, which represent the largest category of asthma-related medical expenses, and the younger ages typical of asthma patients relative to other common illnesses.

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